By Dr. Derick Pasternak, Ambassador, Malaria Science & Research Coordinator, MPI
On 20 May, WHO reported a meeting of African health leaders participating in the 78th World Health Assembly, regarding the growing concern about artemisinin resistance in several East African countries. “Drug resistance is a growing threat that demands urgent, collective action,” said Dr Daniel Ngamije, Director of the WHO Global Malaria Program. “We must act decisively and in solidarity to preserve the tools we have and to ensure access to effective treatments for all in need.”
Alexander, A and Knols, Bart GJ, The 1922 Zionist Launch of Sustainable Malaria Control and an Examination of the Education which Enabled that Control, Malaria World J, 2025 Jun 20, (https://doi.org/10.5281/zenodo.15389413) is an opinion piece that describes not one, but two successful campaigns to eliminate malaria before the age of DDT. The first was led by General Allenby of the British Army in Southern Palestine, which did not last past the end of World War I. The second was started in 1922 by the Zionist scientist Kligler, which eventually succeeded in all of Palestine. Both efforts relied heavily on education of the community and control of mosquito breeding sites.
On 19 June, the Reuters News Agency reported that “Nigerian manufacturer Codix Bio Ltd plans to make millions of HIV and Malaria test kits at its new plant outside Lagos for the local and regional market to help fill gaps in the wake of cutbacks at U.S. donor agency USAID, a company executive said.”
GSK of London and Bharat Biotech of Hyderabad jointly announced on 25 June that they were reducing the price of the RTS,S vaccine by over 50%, to less than USD 5 per dose “progressively to 2028.” At that price, this vaccine will still be more expensive than the R21 vaccine is today.
In late June the NGO, Medicines for Malaria, published its 2024 annual report on 46 slides in English and French. The report is available from the compiler of these summaries or at: https://www.mmv.org/sites/default/files/content/document/AR_Report2024_ENGLISH_final.pdf
On 30 June, “Suriname became the first country in the Amazon region to receive malaria-free certification from the World Health Organization (WHO). This historic milestone follows nearly 70 years of commitment by the government and people of Suriname to eliminate the disease across its vast rainforests and diverse communities. “’WHO congratulates Suriname on this remarkable achievement,’ said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. ‘This certification is a powerful affirmation of the principle that everyone—regardless of nationality, background, or migration status—deserves universal access to malaria diagnosis and treatment. Suriname’s steadfast commitment to health equity serves as an inspiration to all countries striving for a malaria-free future.’”
On 14 July, WHO published a pamphlet entitled Prevention of Re-Establishment of Malaria Transmission, Global Guidance. It is available from the reviewer or at https://www.who.int/news/item/14-07-2025-who-issues-first-ever-guidance-to-support-countries-in-staying-malaria-free
PEER REVIEWED ARTICLES (see notes after citations from non-peer-reviewed publications)
Prevention
Vaccines
Researchers at Oxford University published a paper that may point to a significant advance in malaria vaccine deployment. “The ability to administer both prime and boost immunizations with a single injection would therefore save lives and alleviate health care burdens.” Guyon R & al., Core-Shell Microcapsules Compatible with Routine Injection Enable Prime/Boost Immunization Against Malaria with a Single Shot, Sci Transl Med, 2025 Jun 25; 17(804) eadw2256, https://doi.org/10.1126/scitranslmed.adw2256 presents “a platform for delayed delivery of the booster dose that is scalable with existing technology, easily injectable, and protective against malaria in vivo. Using chip-based microfluidics, [the authors] encapsulated the R21 malaria vaccine in polymer microcapsules that release their content weeks to months postinjection. Coinjecting microcapsules with the priming dose of the R21 vaccine elicited strong antibody responses in a mouse model and provided 85% of the protection of a standard prime/boost schedule. If confirmed in humans, these results would pave the way for rapid deployment of single-shot prime/boost vaccination, an urgently needed global health intervention.”
Njoh AA & al. conducted a nationwide survey of malaria vaccine acceptance in Cameroon and despite significant regional differences, the overall rate was 91% as reported in Malaria Vaccine Acceptance and Associated Factors in Cameroon: A Nationwide Cross-Sectional Survey, Vaccine. 2025 May 30; 60:127323, https://doi.org/10.1016/j.vaccine.2025.127323. “Factors that favor vaccine acceptance include a history of severe malaria …, awareness of the availability of the malaria vaccine for infants …, and working in the vaccination service … Elements reported for vaccine hesitancy include fear of unsafe and negative rumors about the vaccine.”
“Nigeria has a high prevalence of unimmunized and under-immunized children. Also, barriers to effective immunization coverage, on both the demand and supply sides, are rife in the country.” Hassan IA & al., Malaria Vaccine Implementation in Nigeria: Addressing the Coverage Challenges Within the National Immunization Program for High Impact, Vaccine. 2025 Jun 11; 61:127376, https://doi.org/10.1016/j.vaccine.2025.127376 “broadly discusses the prospects of the malaria vaccine implementation in Nigeria amidst the immunization coverage challenges. It draws from review-level evidence to propose four priority areas for improvement within the NPI to achieve a high-impact implementation-i.e., Reach Maximization, Social Mobilization, Program Management, and Progress Monitoring-in line with global immunization strategy frameworks. Evidence-based strategies to influence these domains in the Nigerian context are emphasized.”
Vectors
Sudoi RK & al. Physical and Insecticidal Durability of Permanet® 3.0 and Olyset® Plus Piperonyl Butoxide-Synergist Insecticide-Treated Nets In Sierra Leone: Results of Durability Monitoring from 2020 to 2023, Malaria J, 2025 Jul 13, 24:230, https://doi.org/10.1186/s12936-025-05421-7 is a report of the evaluation of the “performance of two piperonyl butoxide (PBO-synergist) insecticide-treated net (ITN) brands, PermaNet® 3.0 and Olyset® Plus, … under field conditions in two neighboring districts in Sierra Leone over 36 months to estimate median ITN survival, [and to] understand insecticidal efficacy…”. The authors “tracked 370 households and 652 campaign-distributed ITNs from 2020, followed annually for 36 months.” The Permanet 3.0 ITNs outperformed the Olyset Plus ones both in longevity and mosquito killing. However, since the neys were not compared within the same community, the authors caution that there may be confounding factors.
“The main tools to control malaria vectors in sub-Saharan Africa are long-lasting insecticidal nets and indoor residual spraying. However, their sustainability is threatened by the emergence of insecticide resistances, behavioral avoidance and presence of outdoor biting mosquito populations. Thus, complementary interventions such as larval source management, which includes larviciding, are required to achieve better results in malaria vector control.” Dugassa S & al. evaluated “the effectiveness of three larvicides (Aquatain AMF®, Temephos and Bacillus thuringiensis var. israelensis {Bti}) against larvae of Anopheles arabiensisi and Anopheles stephensi.” As the authors report in Evaluation of the Effectiveness of Aquatain, Bacillus thuringiensis var. israelensis, and Temephos on Anopheles arabiensis and Anopheles stephensi Larvae in the Laboratory and Field Settings, Parasit Vectors. 2025 Jun 17; 18:223, https://doi.org/10.1186/s13071-025-06765-4, “[t]he three larvicides, Aquatain, Temephos and Bti, provided high levels of larviciding efficacies in both laboratory and field evaluations.” However, Bgti was less effective against An. stephensi larvae. “Despite its effectiveness, Temephos caused the water to turn whitish and emitted a strong odor that made the community wary regarding the treated habitats. Therefore, [the authors] recommend using Aquatain in mosquito control programs as a complementary malaria vector control tool.”
According to Alemayehu B & al. larval source management (LSM) “has emerged as a vital, yet often overlooked, strategy for vector control… LSM refers to the targeted management of mosquito breeding sites by reducing the number of mosquito larvae for malaria vector control measures. LSM is mainly intended to reduce the availability of breeding sites through environmental management. As a result of interviewing 1,552 households, the authors report in Assessment of Mosquito Larval Source Management Practices for Malaria Elimination in South West Ethiopia People Regional State: A Mixed Study Design Approach, BMC Res Notes. 2025 Jul 3; 18:272, https://doi.org/10.1186/s13104-025-07349-2 that while “58.1% of households had a favorable attitude toward the LSM practice,” only 19.2% engaged in what the authors regard as good practice.
Cathorall ML & al. administered questionnaires to a “convenience sample of 106 adults” in central Uganda and found that most claimed to own and use bed nets. The abstract of their paper, Knowledge, Attitudes, and Practices Regarding Malaria in Rural Uganda: A Cross-Sectional Study, Malaria World J, 2025 Jun 30, 16:14, https://doi.org/10.5281/zenodo.15776707 is non-specific in stating that “[p]erceived susceptibility and barriers were greater among those with a recent diagnosis of malaria within the household.”
“Wolbachia is a natural bacterium that can infect mosquitoes and reduce their ability to transmit diseases. While initially used to control dengue fever, recent research explored its potential for malaria control.” Qu Z & Childs LM, Assessing the Impact of the Wolbachia-Based Control of Malaria, Math Biosci. 2025 Jul 1:109466, https://doi.org/10.1016/j.mbs.2025.109466 is a description of a “mathematical model to assess the potential use of Wolbachia-based strategies for malaria control.”
Bellaio LG & al. collected over 90,000 mosquitoes in the geographic area they studied and ascertained the species of a sample of approximately 1% by polymerase chain reaction (PCR). GThey report in Characterization and Abundance of Malaria Vectors in Sakassou, Central Côte d’Ivoire, Malaria J, 2025 Jun 21, 24:198, https://doi.org/10.1186/s12936-025-05451-1 that 100% of the Anopheles species collected were An. coluzii, which end to bite in the evening up to midnight. They conclude that “both insecticide-treated nets and indoor residual spraying hold promise for malaria vector control. As biting started early in the evening when people tend to be outside, outdoor interventions should also be considered.”
Mashatola T & al. studied vector abundance and identity, using different collecting techniques and concluded that while there was no difference in the species composition using the various methods, the effectiveness of collection depended on the method used. The paper is Assessing Anopheles Species Collection Techniques in a Low Malaria Transmission Area: Implications for Vector Surveillance and Control, Malaria J, 2025 Jul 1, 24:202, https://doi.org/10.1186/s12936-025-05463-x
“…since 2015, transmission [of malaria] has increased due to insecticide resistance and biting at times when people are not using ITNs. Spatial repellents (SRs) may help address these challenges. A double-blinded cluster-randomized controlled trial (cRCT) in Busia County, Kenya, reported that Mosquito Shield™, a transfluthrin-based SR, reduced malaria infections by 33.4% during interim analysis and 32.7% by the end of the study, among children aged 6 months to 10 years.” Ekodir SM & al., Initial Community Response to a Novel Spatial Repellent for Malaria Prevention in Busia County, Kenya, Malaria J, 2025 Jul 4, 24:217, https://doi.org/10.1186/s12936-025-05452-0 describes the response of 30 households in the area in question to two different interviews regarding the use of this method of vector control. “The participants reported a positive initial response to the SR, with a significant perceived reduction in mosquito density and activity. Some also reported concerns about the product’s effectiveness over time and its comparison with existing mosquito control methods, particularly after first replacement. Participants highlighted their perception that the SR provided continuous protection in contrast with the situational protection offered by ITNs. Improvement suggestions included modified installation methods plus a longer-lasting product that protected more space.”
Please see Patel NF & Oliver SV, The Effect of Artificial Cold Selection on the Behaviour and Immune Response of the Major Malaria Vector Anopheles arabiensis (Diptera: Culicidae), Acta Trop. 2025 Jul 3; 268:107731, https://doi.org/10.1016/j.actatropica.2025.107731 below, under Epidemiology/Climate Change, biodiversity & environment
Chemoprophylaxis
“Patients with sickle cell anaemia (SCA) are at risk of severe illness and death if infected by malaria, and lifelong prophylaxis is recommended to individuals in malaria endemic regions. Although its efficacy is declining due to parasite resistance, the antimalarial drug Sulphadoxine-Pyrimethamine (SP) is still given to patients with SCA in several countries of sub-Saharan Africa.” Svege S & al. performed clinical trials in two countries “to compare SP with Dihydroartemisinin-Piperaquine (DP) for malaria chemoprevention in children with SCA.” They report in “I want to Help My Body”: Acceptability of Malaria Chemoprevention Among Children with Sickle Cell Anaemia and Their Caregivers in Malawi and Uganda, PLOS Glob Public Health. 2025 Jul 9; 5(7):e0004056, https://doi.org/10.1371/journal.pgph.0004056 that in focus group discussions, participants “from the DP arm reported a reduced number of sick events and hospital admissions while they were in the trial, and ranked DP above SP in terms of perceived effectiveness. Although concerns were raised about initial side effects, a high pill burden, and the unpleasant smell and taste of tablets, most participants were willing to continue long-term administration of DP due to its observed or experienced health benefits.”
Whereas intermittent preventive treatment of pregnancy (IPTp) is known to improve birth outcomes as well as maternal health, its effectiveness is hampered by the fact that fewer than 50% of pregnant women have been shown in multiple countries to complete the 3-dose course. The same was the situation described in Gutman JR & al., Assessing the Community-Level Impact of Group Antenatal Care on Uptake of Intermittent Preventive Treatment for Malaria in Pregnancy in Atlantique Department, Benin, 2021–2023: A Cluster Randomized Controlled Trial, Malaria J, 2025 Jul 1, 24:205, https://doi.org/10.1186/s12936-025-05412-8. The authors then implemented a model of care called “Group Antenatal Care (G-ANC), [which] is a service delivery model associated with higher quality of and greater retention in ANC. The results showed some increase in completing the 3 dose IPTp regimen in the G-ANC branch of the study compared to the women not in that mode, but the difference was not statistically significant and still below 60%.
van Eijk AM & al. presents a literature review in The Impact of Sulfadoxine–Pyrimethamine Resistance on the Effectiveness of Intermittent Preventive Treatment for the Prevention of Malaria in Pregnancy in Africa: An Updated Systematic Review and Meta-Analysis, Lancet Infect Dis, 2025 Jul 14, https://doi.org/10.1016/S1473-3099(25)00219-1. After reviewing 122 articles covering more than 148,000 individuals, the authors’ conclusion is as follows: “IPTp-SP antimalarial efficacy is greatly reduced in very high resistance areas. However, it remains effective at reducing low birthweight in these areas, possibly through non-malaria effects on fetal growth. While IPTp-SP use should continue in high SP-resistance areas, alternative malaria preventive strategies are urgently needed in these areas.” Neither the abstract nor the article mentions that an alternative regimen of dihydroartemisinin-piperaquine is under investigation for areas with high resistance for IPTp-SP.
Ivermectin use may be considered a form of chemoprophylaxis, since “[s]tudies have shown that ivermectin, used for the treatment of parasitic diseases, can kill malaria vectors that feed on the blood of treated people and thus might be an effective complementary vector control tool if administered widely to communities in malaria endemic regions. Somé AF & al., Safety and Efficacy of Repeat Ivermectin Mass Drug Administrations for Malaria Control (RIMDAMAL II): A Phase 3, Double-Blind, Placebo-Controlled, Cluster-Randomised, Parallel-Group Trial, Lancet Infect Dis. 2025 Jul; 25(7):737-750, https://doi.org/10.1016/s1473-3099(24)00751-5 is a description of a study “to test the safety of repeated, high-dose ivermectin mass drug administration (MDA) and its efficacy for reducing malaria incidence among children when integrated with seasonal malaria chemoprevention (SMC) delivery.” The results were disappointing in that “[r]epeated high-dose ivermectin MDA integrated with SMC distributions at the study site did not reduce malaria incidence among children relative to placebo MDA, despite evidence that, compared with the control group, mosquito survivorship in the first year was reduced in the intervention group the week following MDA and overall improvements in haemoglobin were greater in children in the intervention group.” The authors cite some possible confounding factors.
Likewise, Chaccour C & al., Ivermectin to Control Malaria — A Cluster-Randomized Trial, New Eng J Med, 2025 Jul 23, 393:362-375, https://doi.org/10.1056/NEJMoa2411262 documents that in coastal Kenya, an area of high incidence of malaria, monthly ivermectin MDA for three months for children ages 5 to 15 resulted in 26% fewer cases of malaria than in those who received another drug on a similar schedule. “The incidence of serious adverse events per 100 treatments did not differ significantly between the trial groups.” Steketee RW, Ivermectin Against Malaria — Good News in Bad Times, New Eng J Med, 2025 Jul 23, 393(4):402-404 https://doi.org/10.1056/NEJMe2507797 is an accompanying editorial in which the author calls the above a “well designed study.”
Please see Madejczyk MS & al., In vitro Activity and in vivo Efficacy of Omadacycline Against Plasmodium Species, Malaria J. 2025 Jun 19; 24:194, https://doi.org/10.1186/s12936-025-05448-w under Treatment/New drug research.
Other
Smidler AL & Akbari OS, CRISPR Technologies for the Control and Study of Malaria-Transmitting Anopheline Mosquitoes, Parasit Vectors. 2025 Jul 3; 18:252, https://doi.org/10.1186/s13071-025-06905-w is an article that focuses on CRISPR technology as one way to accomplish the gene-drive approach to Anopheles control.
Diagnosis
General diagnostics
Gebremichael YL & al., Neonatal and Congenital Malaria (NCM): a Case Series in the Tigray Region, Northern Ethiopia, Malaria J, 2025 Jul 1, 24:210, https://doi.org/10.1186/s12936-025-05466-8 calls attention to the importance of keeping malaria in mind when dealing with newborns with fever. “Congenital malaria (CM) is the direct infection of a neonate with malaria parasites from their mother before or during birth. Neonatal malaria (NM) is acquired through mosquito bites after birth during the neonatal period. Both congenital and neonatal malaria (NCM) are potentially life-threatening conditions.” The authors describe six newborns with admitted to a neonatal ICU with fever, who were diagnosed with P. falciparum or P. vivax malaria. Two of them had neonatal malaria, the others, congenital. They were all treated, but one died.
Field diagnostics
The reliability of Rapid Diagnostic Tests (RDTs) has been the subject of many articles. Lindblade KA & al., Assessing the Accuracy of the Recording and Reporting of Malaria Rapid Diagnostic Test Results in Four African Countries: Methods and Key Results, Malaria J. 2025 Jul 1; 24:206, https://doi.org/10.1186/s12936-025-05459-7 focuses on another possible misinterpretation, namely misrepresentation by the health care workers (HCWs) who report the results. In their study that extended to four countries, rigorous retesting yielded accurate reporting results between 80 and 90%. The authors noted that reports inaccurately noted as positive greatly outnumbered those inaccurately noted as negative. They surmise that this indicates willful misreporting at times. Motivation for this remains unclear.
Kouevi AFC & al. hypothesized that the “widespread use of histidine-rich protein 2 (HPR2)-based rapid diagnostic tests (RDTs), specific to Plasmodium falciparum in endemic areas may underestimate the weight of minor species such as P. malariae and P. ovale in malaria transmission.” Using microscopy and PCR, they tested specimens from 207 children with uncomplicated malaria who tested positive for the HRP2 antigen and found evidence that 15 children also had P. malariae or P. ovale or both in their blood. As they point out in Undetected Plasmodium malariae and P. ovale Infections in HRP2 RDT-Positive Children with Uncomplicated Malaria in Nanoro, Burkina Faso, Malaria World J, 2025 Jul 16, 16:15, https://doi.org/10.5281/zenodo.15965746, this is of significant importance, since the latter two species require a different, “radical cure” regimen in order to prevent recurrences.
New diagnostic methods
Individuals with Sickle Cell Disease … have altered red blood cell morphology and atypical immune responses, which can obscure parasite detection. [Obeng DNS & al.] aimed to evaluate the diagnostic performance of … the National Library of Medicine (NLM) malaria screener app in people living with sickle cell disease … The slide screening procedure of the NLM Malaria Screener involves image capture, smear image analysis, result display, and the database, … The mobile application screens both thin and thick blood smear images for Plasmodium falciparum and other malaria species using high-resolution cameras and the processing capabilities of contemporary smartphones” In Performance of a Smartphone-Based Malaria Screener in Detecting Malaria in People Living with Sickle Cell Disease, PLOS Digit Health. 2025 Jun 9; 4(6):e0000884, https://doi.org/10.1371/journal.pdig.0000884, the authors acknowledge that while the app matched the sensitivity of RDT and microscopy, it had significantly less specificity than the other two methods, when compared to PCR as the gold standard. Nonetheless, they consider the method worth pursuing.
Treatment
Treatment results
Plasmodium vivax malaria is common in Ethiopia. Chloroquine and primaquine remain the therapeutic recommendations of WHO for this species of the parasite, for “radical cure,” meaning the prevention of recurrences, to which all forms of malaria except falciparum are prone. Getu E & al., Efficacy of Chloroquine with Primaquine for Uncomplicated Plasmodium vivax Malaria Without G6PD Testing in Northwest Ethiopia: A One-Arm in vivo Prospective Therapeutic Efficacy Study, Malaria J, 2025 Jun 15, 24:192, https://doi.org/10.1186/s12936-025-05446-y reports on the results of 100 patients with uncomplicated vivax malaria, treated with chloroquine and the WHO recommended dose of primaquine, without testing for glucose-6-phosphate dehydrogenase (G6PD) deficiency. By the third day of treatment, all but one of the 92 patients who completed it were free of the parasite. “Common adverse events included abdominal pain (8%) and diarrhea (5%), all of which resolved by day 7… Importantly, no cases of haemolytic anaemia attributable to G6PD deficiency were observed.”
Dereje AA & al., Antimalarial Drug Prescriptions and Clinical Outcomes of Febrile Children in Arba Minch City, South Ethiopia, Malaria J, 2025 Jun 20, 24:197, https://doi.org/10.1186/s12936-025-05449-9 is a report on 350 febrile children seen and treated either in rural health centers or a general hospital. While only about 11% of them were positive for malaria on microscopy, those that were positive for P. falciparum or P. vivax were treated according to WHO recommendations respectively. However, 7 to 9 % of the children treated for malaria were still febrile at the end of seve days’ treatment. The authors conclude that “[t]here was a high adherence to guidelines for prescribing antimalarial drugs at both higher- and lower-level healthcare facilities, accompanied by favourable clinical outcomes. However, the proportion of persistent fever and patient visits to other healthcare facilities after initial management underscores the need for additional diagnostic tools, including biomarker assays, to identify bacterial causes of fever.”
The results of four different treatment regimens for uncomplicated P. falciparum infection are described in Nhama A & al., Efficacy of Artemether-Lumefantrine, Artesunate-Amodiaquine, Dihydroartemisinin-Piperaquine and Artesunate-Pyronaridine for the Treatment of Uncomplicated Plasmodium falciparum Malaria in Mozambique, 2022, Malaria J, 2025 Jul 14, 24:231, https://doi.org/10. /s12936-025-05473-9. The efficacy of all four regimens was described as over 90% and all drugs were reported to be “well tolerated, with adverse events reported in less than 2% of the participants.”
Side effects and complications
None this month
Guidelines
None this month
Drug resistance
While Alemayehu AA & al. found continued sensitivity to ACT in a sample of 98 patients with malaria, they report that a genetic mutation associated with drug resistance was found in 9.6% of parasite samples taken from these oatients. The paper is Expansion of the Plasmodium falciparum Kelch13 R622I Mutation in Northwest Ethiopia, Open Forum Infect Dis. 2025 May 9; 12(6):ofaf279, https://doi.org/10.1093/ofid/ofaf279
Through genetic analysis, Kojom Foko LP & al.’s paper, Genetic Epidemiology of Plasmodium falciparum Chloroquine Resistance in Coastal, North and Far North Areas of Cameroon, Trans R Soc Trop Med Hyg. 2025 Jul 10: traf069, https://doi.org/10.1093/trstmh/traf069 describes how P. falciparum specimens collected from patients in the coastal area of Cameroon have re verted to chloroquine sensitivity, while those collected from the North and Far North areas remain resistant.
Another genetic analysis of drug resistance, Assey A & al., Artemisinin and Partner Drug Resistance Markers in Plasmodium falciparum from Tanzanian Paediatric Malaria Patients, 2016–2022, Malaria J, 2025 Jul 1, 24:209, https://doi.org/10.1186/s12936-025-05447-x reports that 7% of 143 P. falciparum specimens processed mutations, but only a single specimen contained a mutation that was identified by WHO as being associated with artemisinin resistance.
Taylor WR & al., Single Low Dose Primaquine to Block the Transmission of Plasmodium falciparum-Proposed Stand-Alone and ACT-Adapted Regimens, BMC Med. 2025 Jul 1; 23:397, https://doi.org/10.1186/s12916-025-04153-4 reports that “[d]espite the 2012 WHO recommendation to add single low dose primaquine (SLDPQ, 0.25 mg/kg body weight) to artemisinin-based combination treatments (ACTs) for blocking the transmission of artemisinin-resistant Plasmodium falciparum, there are currently no weight-based regimens founded on robust evidence.” Based on extensive pharmacologic studies, the authors recommend that WHO “reinstate the 3.75 mg tablet [of primaquine] for prequalification and determine which regimens should be incorporated into their treatment guidelines to advance malaria elimination.” The paper but not the abstract cites evidence that this regimen is safe in the large majority of patients with G6PD.
New drug research
Omadacycline (trade name Nuzyra) is a broad-spectrum antibiotic related to tetracycline. “Doxycycline is currently the only tetracycline-class antibiotic recommended for malaria prophylaxis,” which has the disagreeable side effect of increasing skin sensitivity to sunlight. Madejczyk MS & al., In vitro Activity and in vivo Efficacy of Omadacycline Against Plasmodium Species, Malaria J. 2025 Jun 19; 24:194, https://doi.org/10.1186/s12936-025-05448-w describes experiments that demonstrate that omadacycline had “comparable in vitro activity to doxycycline against both drug-sensitive and drug-resistant P. falciparum clones, while doxycycline showed reduced activity against two drug-resistant clones.” Omadacycline was also effective in the laboratory against two different animal malaria species. The authors recommend support for “further investigation of omadacycline as a potential candidate for malaria prophylaxis and treatment.”
Plant extracts and traditional treatments
Spondias mombin, or hog plum, was native to the Americas, but has been introduced in Africa, South and Southeast Asia as well. Based on laboratory studies using the mouse parasite P. berghei, Nwankwo NE & al.’s article, Antimalarial Potentials, Toxicological Impacts, and Gas Chromatography-Mass Spectrometric Analysis of Ethanol Extract of Spondias mombin Linn, Exp Parasitol. 2025 Jun 28; 275:108984, https://doi.org/10.1016/j.exppara.2025.108984 describes what the authors interpret as conclusive evidence that the “ethanol extract from Spondias mombin shows promise as a malaria adjuvant treatment.”
“Drawing on the success of plants like Artemisia annua in the development of modern anti-malarial drugs,” Onukansi FO & al., Investing in Traditional Medicine: Leveraging Evidence and Innovative Research to Strengthen the Fight Against Malaria in Nigeria, Malaria J, 2025 Jul 15, 24:232, https://doi.org/10.1186/s12936-025-05359-w “emphasizes the need for comprehensive investment in TM (traditional medicine) research.” The authors state that “systematic reviews and multiple studies have been conducted on herbs, such as Vernonia amygdalina (bitter leaf), Cinchona, Argemone mexicana, and Azadirachta indica (neem) for malaria treatment. These studies demonstrate that traditional healers employ a wide range of herbs as anti-malarial remedies.” It is then their opinion that by “integrating traditional medicine into national health systems, Nigeria could unlock new strategies for combating malaria and other infectious diseases, advancing toward sustainable health outcomes.”
Other
None this month
Campaigns and Policies
“Multiple challenges hinder malaria control in Angola, including climatic variability, ineffective vector control, population displacement, socioeconomic inequalities, and increasing resistance to anti-malarial drugs and insecticides. … Despite a 36% reduction in malaria mortality since 2000, Angola remains off track to meet the Global Technical Strategy (GTS) targets for 2025, with no significant progress recorded in reducing malaria mortality between 2015 and 2023.” Domingos ES, Rethinking Malaria Elimination: A Perspective on Challenges and Solutions in Angola, Malaria J, 2025 Jul 2, 24:214, https://doi.org/10.1186/s12936-025-05398-3 “analyses Angola’s malaria landscape, emphasizing that persistent healthcare system weaknesses such as financial instability, workforce shortages, poor disease surveillance, and regional disparities in intervention coverage, necessitate urgent, tailored responses. Drawing from lessons learned in successful malaria elimination programmes in Cabo Verde, Algeria, China, and the recent WHO recommendations, the study recommends the implementation of three integrated strategies: (i) mass drug administration, to rapidly reduce transmission and help consolidate malaria control; (ii) intermittent preventive treatment for school-age children, to protect a high-risk yet often overlooked population; and (iii) post-hospitalization malaria prevention to decrease readmissions and mortality linked to severe malaria episodes.”
“The coronavirus disease 2019 (COVID-19) pandemic posed significant threats to maintaining malaria services in Nigeria and threatened to reverse global progress towards elimination of the disease.” Manning EK & al. “worked in collaboration with the National Malaria Elimination Programme in Nigeria across 11 states to ensure that malaria campaigns and routine services continued.” In Delivery of Malaria Services During a Pandemic: Lessons from COVID-19 in Nigeria, Int Health. 2025 Jul 8: ihaf074, https://doi.org/10.1093/inthealth/ihaf074 they “share the challenges and experiences from developing and implementing operational guidelines that enabled programmes to be adapted during unpredictable situations. The modifications made to long-lasting insecticide-treated net distribution and seasonal malaria chemoprevention campaign strategies enabled wide coverage of these interventions, despite limitations imposed by lockdowns. Strong partnerships were essential for the continued delivery of malaria services during lockdowns, which also highlighted the importance of community health workers during emergencies.”
Epidemiology
Climate change, biodiversity and environment
Using modeling, Yehouenou Tessi DR & al., Does Climate Change Influence the Spread of Malaria in Benin? Insights from Ecological Niche Modeling for Surveillance Efforts, Int Health. 2025 Jun 9: ihaf064, https://doi.org/10.1093/inthealth/ihaf064 reports that two scenarios were considered by the authors; one included successful mitigation of greenhouse gas emissions, the other did not. Under both scenarios, climate change is expected to exacerbate the spread of A. gambiae, increasing the disease risk across the country.
Also reporting on modeling, Tariq A & al.’s paper, Modelling the Effects of Precipitation and Temperature on Malaria Incidence in Coastal and Western Kenya, Malaria J. 2025 Jul 1; 24:208, https://doi.org/10.1186/s12936-025-05428-0, report positive correlations “of malaria incidence with rainfall and temperature in [Western Kenya] and a positive correlation between malaria incidence and rainfall and a negative correlation between malaria incidence and temperature in [coastal Kenya].” The lags between rainfall and malaria incidence in the two areas studied was estimated between 7 and 15 weeks.
“Although arid, the Sahel is highly susceptible to vector-borne diseases, and [is] a malaria endemic zone. After decades of drought, rainfall is increasing again, leading to a sustained increase in malaria transmission in the region. Changes in land use and urbanization are also modulating human-vector contacts and thus the incidence of malaria. Djedanem M & al., Intense Rainfalls and Floods Reshape Malaria Transmission in Niger, Acta Trop. 2025 Jun 15: 107699, https://doi.org/10.1016/j.actatropica.2025.107699 states that “in Niger, transmission is increasing, but also spreading during the dry season, especially in areas closed to wild water and flooding. In the same vein, malaria morbidity is no longer largely confined to children under five. [The authors conclude that] preventive measures, including chemoprevention of seasonal malaria and indoor residual spraying, which are currently used only during the rainy season, need to be redesigned as part of a rethink of current prevention strategies.”
Patel NF & Oliver SV studied the effect of different temperatures under laboratory conditions on two strains of An. arabiensis, one sensitive to insecticides and one resistant. “The cold selection had variable effects on the two strains. Cold selection significantly increased adult female longevity at 18°C in [the resistant strain] but not [the sensitive one]. By contrast, cold selection increased landing at 20°C in [sensitive strain] but not [the resistant one]. However, it decreased biting success at 20°C in both strains.” Hence the authors’ conclusion that “winter survival [of] An. arabiensis is associated with increased longevity and reduced feeding success.” The paper is The Effect of Artificial Cold Selection on the Behaviour and Immune Response of the Major Malaria Vector Anopheles arabiensis (Diptera: Culicidae), Acta Trop. 2025 Jul 3; 268:107731, https://doi.org/10.1016/j.actatropica.2025.107731
Risk factors
In a study by Modi D & al. to determine “the prevalence and factors associated with recurrent malaria episodes among children under five at Kayunga Regional Referral Hospital,” Factors Associated with Recurrent Malaria Episodes Among Children Under Five at Kayunga Regional Referral Hospital in Kayunga District, Central Uganda, PLoS One. 2025 Jun 12; 20(6):e0320112, https://doi.org/10.1371/journal.pone.0320112, the authors report that recurrence rate in the hospital studied was as high as 84%. The factors significantly associated with recurrent malaria episodes were; children from houses that were annually sprayed …, children from houses that were not sprayed …, children who were treated with quinine antimalarial in the previous infection …, and children who were residing in a house whose windows were closed at 7-8 pm.” The authors conclude that the “recurrence of malaria episodes among children under five is significantly high, suggesting the possibility of malaria resistance…. Malaria prevention programs should consider biannual indoor residual spraying in high malaria transmission areas using vector-susceptible insecticides.”
Countries and regions that have made progress in eliminating malaria that are bordered by or in close proximity to countries that have not yet succeeded at it, are at risk of continuous reintroduction. Two cases in point are the island of Zanzibar, as described by Muller JG & al. in Integrating Mobility, Travel Survey, and Malaria Case Data to Understand Drivers of Malaria Importation to Zanzibar, 2022-2023, medRxiv [Preprint]. 2025 Jun 5: 2025.06.04.25327997, https://doi.org/10.1101/2025.06.04.25327997 {medRxiv publishes articles that have not undergone peer review} and the island country of Cabo Verde, as in DePina AJ & al., Imported Malaria in Cabo Verde (2010-2024): Risks to Post-Elimination Stability, PLOS Glob Public Health. 2025 Jun 12; 5(6):e0004592, https://doi.org/10.1371/journal.pgph.0004592.
“Screening of blood donors for malaria parasites as recommended by the World Health Organization (WHO) is currently not included in the protocols and procedures for pre-screening blood donors of many private and public health facilities in Nigeria.” Aluh ST & al., Prevalence of Malaria Parasites Among Blood Donors in Two Hospitals in Enugu Metropolis, Nigeria, Hematol Transfus Cell Ther. 2025 Jun 18; 47(3):103858, https://doi.org/10.1016/j.htct.2025.103858 reports that in the two hospitals studied, 148 of 377 blood donors studied (39.7%) were found to have malaria parasites in their blood. The percentages were higher among donors between ages 16 and 35 than among older donors. The authors urge routine screening of potential blood donors for malaria, as recommended by WHO.
“… asymptomatic cases [of malaria] contribute to ongoing transmission and hinder elimination efforts. Asymptomatic individuals act as hidden reservoirs, sustaining onward malaria transmission. [Silwamba W & al.] aimed to determine the prevalence and risk factors of asymptomatic malaria in Mwandi District, Zambia.” As they report in Hidden Reservoirs of Infection: Prevalence and Risk Factors of Asymptomatic Malaria in a High-Endemic Region of Zambia, Malaria J. 2025 Jul 8; 24:221, https://doi.org/10.1186/s12936-025-05472-w 4/1% of a relatively small sample of 370 asymptomatic individuals were found by microscopy to harbor Plasmodium parasites. While “females had significantly lower odds of asymptomatic malaria compared to males” and there were differences in the rates of asymptomatic malaria based on geography, the authors state that “[n]o significant associations were found with insecticide-treated net use, indoor residual spraying, or socioeconomic status.”
General epidemiology
Whereas the abstract of Ngutu M & al., Gender-Related Factors Affecting Community Malaria-Related Perceptions and Practices in Migori County, Kenya, Malaria J, 2025 Jun 19, 24:196, https://doi.org/10.1186/s12936-025-05336-3 deals mostly in generalities, such as “…malaria healthcare-seeking, knowledge, attitudes and practices and the perceptions of risk and vulnerability are influenced by gender roles and relations and intersections among socio-demographic factors…,” the article itself makes it clear that “[w]omen were notably more able to access knowledge on malaria during hospital visits, linked to their healthseeking (sic) behaviour and their primary caregiving roles that meant more frequent visits to healthcare facilities. As such more women than men had more access to malaria sensitization and knowledge initiatives, manifesting a gendered dimension to health information access…”
Zewale TA & al. assessed the burden of malaria in Eastern Africa “using age-standardized incidence, prevalence, mortality, and DALY (disability adjusted life years) rates, stratified by age, sex, and countries… Malaria incidence, mortality, prevalence and DALYs declined significantly in Eastern Africa region from 1990 to 2021. The rate of incidence, prevalence, mortality and DALYs of malaria in Eastern Africa decreased by 54%, 61.8%, 62%, and 63.8%, respectively. However malaria burden remained highest among children under five, with DALYs peaking in neonates aged 7–27 days. In 2021, South Sudan had the highest age-standardized incidence and prevalence rate whereas Uganda recorded the highest malaria mortality and DALY rate. The Comoros showed significant declined in malaria burden, whereas Ethiopia experienced an increase in all metrics from 1990 and 2021. Child underweight and stunting were the major risk factors for malaria-related DALYs and deaths in 2021. The article is Trends of Malaria Incidence, Prevalence, Mortality, and Disability-Adjusted Life Years in Eastern Africa Region from 1990 To 2021: A Systematic Analysis from Global Burden of Disease 2021 Study, Malaria J, 2025 July 1, 24:207, https://doi.org/10.1186/s12936-025-05364-z.
Spatiotemporal studies
Mesele FB & al., Prevalence of Malaria and Its Associated Factors Among Adults Living in Samre Woreda, Tigray, Ethiopia, 2023/24: A Community-Based Cross-Sectional Study, BMC Public Health. 2025 Jun 10; 25(1):2162,https://doi.org/10.1186/s12889-025-23423-7
Berthé I & al., Geo-Temporal Study of Clinical Malaria in an Endemic Zone in Southern Mali: The Case of the Kolondieba Health District from 2019 to 2021, Malaria World J, 2025 Jun 20, 16:12, https://doi.org/10.5281/zenodo.15676301